16thAnnualAgingConcernsUniteUs(ACUU) conference(ACUU)conference

Understanding the UAS‐NY

UAS-NYUAS NY

Uniform Assessment System – New York

UAS-NY

Uniform Assessment System – New York

Carla R. WilliamsDeputy Director,

Division of Long Term Care,Office of Health Insurance ProgramsOffice of Health Insurance Programs

22

UAS –NY: GoalUAS–NY:Goal

Develop a comprehensive assessment instrument that:

evaluates an individual’s health status, strengths, care needs and preferencescare needs, and preferences. 

guides the development of individualized long term care service plans.care service plans.

ensures that individuals with long term care needs receive the right care, within the right setting and at the right time.

33

Current EnvironmentCurrentEnvironment

multiple screening and assessment tools in current usemultiple screening and assessment tools in current use complicates an already fragmented and poorly coordinated delivery system

many instruments lack standardization, have not been tested for reliability or validity, and are not automated

care plans and referrals are open to subjectivity

44

Objectives of UAS ‐NYObjectivesofUAS‐ NY

i di id l’ f ti l d d biliti th hassess individual’s functional needs and abilities through empirically tested and validated meansprovide accurate data to develop individualized plans of care that are consumer‐driven, build on consumer strengths and offer consumer choiceidentify level of careidentify level of careassist with care planning and oversightreduce redundancy

55

ObjectivesObjectives

improve the quality, consistency, and accuracy of assessment and care plansenhance the state’s capacity for program developmentenhance the state s capacity for program development and policy decisions that are data‐drivenincrease access to data by multiple providers via l t ielectronic meansprovide compatibility with other data sets and align with existing standards to the extent possible

66

BackgroundBackground

extensive review of literature to identify uniform data ysets and assessment instruments developed by other states and countries

secured expertise to validate preliminary findings and recommendations

77

LearningfromOtherStatesandCountries

Conducted focused discussions about uniform assessmentConducted focused discussions about uniform assessment instruments, e.g., Washington, Michigan, Massachusetts, New Jersey, Maine, Louisiana, Canada.

why particular tool was chosen/developedhow business plan developed, from goals to implementationpfunctions of the toolsettings in which the tool is usedstake holder supportstake holder supportscreening process to determine who gets the in‐home assessment

8training needs and resourcesinter‐rater reliability

8

Tool SelectionToolSelection

two possibilities surfaced: CMS CAREinterRAI Community Health AssessmentinterRAI Community Health Assessment

an interRAI Community Health Assessment was chosen (interRAI CHA)

99

Capabilitiespevaluates an individual’s health status, care needs and preferencespreferencesby design, compatible in key areas with the nursing home RAIconsistent, standardized, and validated level of care and assessmentassessmentautomatablehigh inter‐rater reliabilityd t t b d tti ith t i ti fdata set can be used across settings with customization for specific settingsreasonable length of assessment

il bl favailable for use

1010

DevelopmentforSoftwareandTrainingp g

evaluate the interRAI CHA vis‐à‐vis programs and l iregulations

map the current assessment process in all programsdocument use of the current assessmentidentify outcomes and initiate curriculum for assessor education programcomputer readiness survey of userscomputer readiness survey of usersbeta testing preparationweb‐based training being createdt i i t l i t d i t fttraining tools incorporated into software

1111

ScopeScopeAssessment:

Community Health AssessmentCommunity Health AssessmentFunctional SupplementMental Health Supplement

lScales, Triggers, CAPs, RUG IIINew York State Adds: 

Skilled Nursing Facility Level of Careg yNew York State‐Specific Data

Summary Output Will Support:Service PlanningService PlanningCare PlanningCase Management

1212

UAS‐NYContent:List ofAssessmentTools in the SuiteListofAssessmentToolsintheSuite

Current UAS‐NY Tools:Community Health Assessment (Home Care)Community Health Assessment  (Home Care)

Functional SupplementMental Health Supplement

Other Tools Available for Future:Other Tools Available for Future:Community Mental Health Mental Health Acute CareAcute Care Post‐Acute Care Contact Assessment Long Term Care FacilityLong Term Care Facility Assisted Living Emergency Screener for Psychiatry  Palliative Care 13Palliative Care Intellectual Disability

13

UAS‐NYContent:AssessmentTool FeaturesAssessmentToolFeatures

t l h if d t ttools have a common uniform data set 

tools contain assessment domains

assessment domains contain subcategories

subcategories contain items (questions)

scales embedded to assist in measuring severity of needs

scores and algorithms produce outcomes

1414

UAS‐NYContent:DomainsandSub‐Categoriesg

• Instrumental Activities

Sub‐Categories

L ti /W lki• Instrumental Activities of Daily Living (IADLs)

• Activities of Daily Living (ADLs)

Functional Status

• Locomotion/Walking

• Physical Function Improvement Potential

• Falls• Dyspnea• Pain Symptoms

b l h l dHealth Conditionsai

ns

• Balance• Pulmonary • Neurological

• Tobacco, Alcohol and Substance Abuse

• Skills for Daily Decision

Dom

• Instability of Conditions

• Periodic Disordered• Skills for Daily Decision Making

• Memory Recall Ability• Change in Decision 

Making

Cognition

• Periodic Disordered Thinking or Awareness

• Acute Change in Mental Status from Usual Functioning 1515

UAS‐NYContent:AssessmentOutcomesAssessmentOutcomes

Level of CareLevel of Care

Clinical Assessment Protocols

Quality IndicatorsQuality Indicators 

Aggregate Reports

Ad H R tiAd Hoc  Reporting 

Resource Utilization Groups

1616

DevelopingtheUAS‐NYApplicationp g pp

Obtained application development expertise pp p pdefined system requirements and issued an RFPsolicited and evaluated proposals

Procured expertise to build the software application:GCOM S ft & CIM f li ti d l tGCOM Software & CIM for application developmentNYSTEC to assure software quality and completeness

Conducting an iterative system development cyclemeasure progress and quality throughout system development

17enables us to adjust to changing circumstances

17

UAS‐NYDevelopmentCyclep y

Iterative Development Cyclep yIteration 1:  May – July 2012Iteration 2:  August – November 2012

i 3 b h 20 2Iteration 3:  November – March 2012Iteration 4:  BETA April‐ August 2012Revision and System Evolution:  August 2012‐ Oct 2012Final Testing:  October – November 2012Pilot Implementation:  November 2012 – February 2013

State‐wide ImplementationFebruary/March 2013 onward

1818

UAS‐NY System ArchitectureUAS NYSystemArchitecture

Web‐based software applicationppInternet Explorer and FireFoxSecure connection (https:\\) 128‐bit encryption

Health Commerce System (HCS) Web Portal IntegrationHCS User LoginSystem SecurityRole‐based system

On‐line and Off‐line capabilitiesOn‐line: access from any computer that has internet access and approved browser 19approved browserOff‐line: from a laptop computer if internet not available 

19

BetaTestGoals

provide insight into system technical stability

inform statewide roll‐out strategygy

provide insight into organizational ability to integrate UAS‐NY into business practicesintegrate UAS‐NY into business practices

provide insight on UAS‐NY impact on d i di id lassessed individuals

2020

BetaParticipantsAdirondack Manor Home for Adults

Albany County DSS

Amber Court of Westbury

Montefiore Home Agency

Nassau County Department of Social Services

New York City Human Resource Administration

Broome County Community Alternative System Agency

Catholic Health Systems

Chautauqua Department of Social Services

Chemung Department of Social Services

New York Congregational LTHHCP 

Otsego Department of Social Services/NY Connects

Otsego Manor LTHHCP

Parker Jewish Instituteg p

Eddy Visiting Nurse Association

Elant Choice

Elderplan

ElderServe Health

Senior Health Partners, Inc.

Sunrise & Lakeside Adult Day Health Care Programs

Total Aging in Place

Unity Health SystemsElderServe Health

Elderwood Village at Westwood

Emblem Health

Erie Department of Social Services

Fid li

Unity Health Systems

VIP Health Care

Visiting Nurse Association of Long Island

Visiting Nurse Service and Hospice of Suffolk, Inc.

Vi i i N S i f N Y k CHOICE

21

Fidelis

GuildNet

Gurwin Jewish Nursing and Rehabilitation Center

McAuley Assisted Living

Visiting Nurse Services of New York ‐ CHOICE 

Visiting Nurse Services of New York ‐ Home Care

Warren County Health Services 

Warren Department of Social Services21

Medford Hamlet

Metropolitan Jewish Long Term Home Care

Monroe Department of Social Services

Willcare ‐ Buffalo

Wellcare of New York

Westchester Department of Social Services

BetaTestActivities

l ti th lf d li th tcompleting the self‐paced, online courses that are available through the UAS‐NY Training EnvironmentEnvironment

conducting the UAS‐NY Community Assessment

using report options 

reviewing current business practices to identify changes to support UAS‐NY acceptance

2222

Foradditionalinformationvisit:

http://www.health.ny.gov/facilities/long_term_care/#uas_ny

Questionsmaybeemailedto:

uasny@health.state.ny.us

2323